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Vol. 149. Issue 6.
Pages 240-247 (September 2017)
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Vol. 149. Issue 6.
Pages 240-247 (September 2017)
Original article
DOI: 10.1016/j.medcle.2017.08.004
Effectiveness of a simple intervention on management of acute exacerbations of chronic obstructive pulmonary disease and its cardiovascular comorbidities: COREPOC study
Efectividad de una intervención simple sobre el tratamiento de las agudizaciones de la enfermedad pulmonar obstructiva crónica y de sus comorbilidades cardiovasculares: estudio COREPOC
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Jesús Díez-Manglanoa,b,c,
Corresponding author
jdiez@aragon.es

Corresponding author.
, Jesús Recio Iglesiasd,e, José Manuel Varela Aguilarf,g, Pere Almagro Menah, Gabriel Zubillaga Garmendiai, the researchers from the COREPOC study, on behalf of the COPD group of the Spanish Society of Internal Medicine
a Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Grupo de investigación en Comorbilidad y Pluripatología en Aragón, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
c Departamento de Medicina, Dermatología y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain
d Servicio de Medicina Interna, Hospital Vall d’Hebron, Barcelona, Spain
e Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
f Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain
g Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Biomedicina de Sevilla, Sevilla, Spain
h Servicio de Medicina Interna, Hospital Universitario Mutua de Terrassa, Terrassa, Barcelona, Spain
i Servicio de Medicina Interna, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
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Table 1. Analysis by patients of the effectiveness of the intervention on the essential items regarding general recommendations and treatment of chronic obstructive pulmonary disease.
Table 2. Analysis by patients of the effectiveness of the intervention on the essential items of treatment recommendations for comorbidities.
Table 3. Analysis by hospitals of the effectiveness of the intervention on the essential items regarding general recommendations and treatment of chronic obstructive pulmonary disease.
Table 4. Analysis by hospitals of the effectiveness of the intervention on the essential items regarding treatment recommendations for comorbidities.
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Abstract
Background and objective

To determine the effectiveness of a simple educational intervention to improve the management of cardiovascular comorbidities in patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (COPD).

Material and methods

Multicenter study participated in by 26 hospital centers. A panel of experts elaborated a set of recommendations about diagnostic and therapeutic management of acute exacerbation of COPD and cardiovascular comorbidities (coronary artery disease, atrial fibrillation, heart failure and diabetes). The recommendations were graduated as indispensable, advisable and outstanding. Compliance with recommendations were assessed in the discharge letter for COPD patients hospitalized with acute exacerbation in Internal Medicine departments. The protocols to treat the comorbidities in COPD were explained in a clinical session. After 6 months’ compliance with recommendations they were reassessed.

Results

A total of 390 cases before and after the intervention were assessed. There was significant progress in 53% of cases. The improvement was greater in cases referred to general management and COPD management (66.7 and 76.9%, respectively), and lower in cases referred to ischemic heart disease (11.1%) and none in those referred to coronary artery disease. After the intervention, the adherence to overall and indispensable recommendations was higher (p=0.020 and p=0.017, respectively) and a trend to improve was observed in advisable (p=0.058) and outstanding recommendations (p=0.063).

Conclusions

A simple intervention can improve the management of lung disease in COPD patients with an acute exacerbation, but has less effect on the management of comorbidities.

Keywords:
Chronic obstructive pulmonary disease
Myocardial ischemia
Atrial fibrillation
Heart failure
Diabetes
Clinical trial
Resumen
Fundamento y objetivo

Analizar la efectividad de una intervención educativa simple para mejorar el tratamiento de las comorbilidades cardiovasculares en los pacientes hospitalizados por una exacerbación de enfermedad pulmonar obstructiva crónica (EPOC).

Material y métodos

Estudio multicéntrico con participación de 26 hospitales. Un grupo de expertos elaboró unas recomendaciones para el abordaje diagnóstico y terapéutico de la EPOC y las comorbilidades cardiovasculares (cardiopatía isquémica, fibrilación auricular, insuficiencia cardiaca y diabetes) que se graduaron como imprescindibles, aconsejables y sobresalientes. Se recogió el cumplimiento de las recomendaciones en los informes de alta de los pacientes ingresados en los servicios de Medicina Interna por reagudización de la EPOC. Se realizó una sesión clínica explicando los protocolos de atención a las comorbilidades en la EPOC y al cabo de 6 meses se volvió a observar el cumplimiento de dichas recomendaciones.

Resultados

Se recogieron 390 casos antes y después de la intervención. Hubo mejoría significativa en el 53% de los ítems y esta mejoría fue mayor en los referidos al tratamiento general (66,7%) y al tratamiento de la EPOC (76,9%) y menor en los referidos a la cardiopatía isquémica (0,0%) y a la insuficiencia cardiaca (11,1%). Tras la intervención mejoró el cumplimiento de las recomendaciones en general (p=0,020) y de las imprescindibles (p=0,017), con una tendencia a la mejoría en las aconsejables (p=0,058) y las sobresalientes (p=0,063).

Conclusiones

Una intervención simple puede mejorar la atención a los pacientes con exacerbación de EPOC, especialmente en el tratamiento de la enfermedad pulmonar, con pequeños cambios en el de las comorbilidades.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Isquemia miocárdica
Fibrilación auricular
Insuficiencia cardiaca
Diabetes
Ensayo clínico

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